WQ0018816_Application (FTSE)_20220708

Original FTA received 7-8-2022 State of North Carolina
Additional info received 10-19-2022 Department of Environmental Quality
DWR Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: WQ0018816 (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Trinity (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Stevie Cox per 15A NCAC 02T .0106(b)
Title: City Manager
4. Applicant's mailing address: PO Box 50
City: Trini State: NC Zip: 27370-0050
5. Applicant's contact information:
Phone number: [phone] Email Address: citymanagerktrinity-nc.gov
II. PROJECT INFORMATION:
1. Project name: City of Trinity Lift Station & Force Main Regionalization Project
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: WQ0018816 and issued date: 9/8/2000
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Randolph, Davidson, and Guilford Counties
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.86006' Longitude:-80.039433'
5. Parcel ID (if applicable): 6796199530 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: J. Clark Maness License Number: 047235
Firm: WithersRavenel, Inc.
Mailing address: 115 MacKenan Drive
City: Cary State: NC Zip: 27511-7903
Phone number: [phone] Email Address: cmanessawithersravenel.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Westside WWTP Permit Number: NCO024228
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ (Data not available, Ensley Creek Sewer Outfall was constructed in 1958/1961)
2. Downstream (Receiving) Sewer Information: 18 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00010
Owner Name(s): City of High Point
FORM: FTA 06-21 Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ® N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑ No ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100% Domestic _% Commercial _% Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ❑ No
➢ If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a,b
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total T
GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
® Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
® Flow has already been allocated in Permit Number: WQ0018816 Issuance Date: 4/16/2001
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Puma Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Steeplegate Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.86006' Longitude:-80.03943'
3. Total number of pumps at the pump station: Two
3. Design flow of the pump station: 17 millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): 1,181 gallons per minute (GPM) at 218 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
12
30,000
C900 PVC
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01 C.l.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
® Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B)_
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(_f)&(g)? ® Yes ❑ No
15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
ZWater mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
ZWater mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T.0305( or (g), see Section X.1 of this application
*15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: Randleman Lake ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ®Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0I05(c)(6), directly related environmental permits or certification applications must be being prepared,
have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedimentation control plans, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the approval of the permit, and proiects requiring a variance approval may be subiect to longer
review times. For proiects requiring two or more variances .or where the variance is determined by the Division to be a
significant portion of the proiect, the full technical review is required.
2. Professional Engineer's Certification:
CLAN MANESS , attest that this application f6rC11Y OF tRlNlif LIFT STA•fian/�•GoRCEIhn►1�✓R6Gn ns
(Professional Engineer's name from Application Item III.1.) (Project Name from Application Item fl.1) 111var r
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
W L"IIas i
I, Stevie L. Cox , attest that this application for City of Trinity Lift Station & Force Main Regionalization Project
(Signature Authority Name from Application Item I.3.) (Project Name from Application Item II.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: e_ .XyDate: �- `►:2�
FORM: FTA 06-21 Page 5 of 5

Maness, Clark
From: [e-mail]
Sent: Tuesday, October 18, 2022 5:24 PM
To: Rodney Johnson; Maness, Clark
Cc: Hawkins, Carolyn; Cowan, Bill
Subject: FW: Trinity - Lift Station and Force Main - Fast Track Application Changes
Attachments: RE: [External] RE: Incomplete Application: Trinity Lift Station and Force Main Regionalization Project;
FTA-06-21 - Trinity Regionalization.docx; Trinity Phase 1A Sewer Improvements -Permit
WQ0018816.pdf
Importance: High
Clark,
I have had an opportunity to review the attached emails and support documents. I am good with us moving forward
with resubmitting for a fast track application for the completion of the Steeplegate Pump Station. Please let me know
what else is needed from me and I will turn it around back to you. I am going to be "in and out" of the office most of
until about 2 PM on Wednesday, October 19tn
If you should have additional questions, please feel free to give me a call at: [phone].
Sincerely,
Stevie Cox
City Manager
City of Trinity
P.O. Box 50
5978 NC Highway 62
Trinity, North Carolina 27370
Email: ci . managerktrinity-nc.gov
Phone: [phone]
Fax: [phone]
All email correspondences to and from this address is subject to the North Carolina Public Records Laws, which may
result in monitoring and disclosure to third parties, including law enforcement.
This institution is an equal opportunity provider and employer.

From: Maness, Clark <[e-mail]>
Sent: Tuesday, October 18, 2022 5:41 AM
To: [e-mail]; [e-mail]
Cc: Hawkins, Carolyn <[e-mail]>; Cowan, Bill <[e-mail]>
Subject: Trinity - Lift Station and Force Main - Fast Track Application Changes
Importance: High
Good morning Stevie and Rodney,
The State Division of Water Resources would initially not accept our Fast Track Application for completing modifications
to the Steeplegate Pump Station (as part of the regionalization project with the City of High Point) because we did not
have a copy of the existing permit for the pump station. However, we have found a copy of the original permit
(attached as PDF for your records), and now we can simply resubmit the application document without having to mail in
an original signature page.
Stevie, per the attached email from the State, in order to do this we need you as the person with signature authority to
review the attached FTA-06-21 again and confirm via email that you are ok with the changes. The only change we have
made in the application is to add in the correct pump station permit number under Section II and Section VI-8.
Please review and respond to this email as soon as you are able, and let me know if you have any questions.
Regards,
Clark Maness, PE
INN Wither Ra enel
ip0Wk00W~% Rrm
115 MacKenan Drive I Cary, NC 27511
Office:919.469.3340 1 Direct:919.535.5213
[e-mail]
CONFIDENTIALITY AND NONDISCLOSURE

40 WithersRavenel
NoOur People. Your Success.
October 19, 2022
City of Trinity Lift Station & Force Main Regionalization
Application Narrative in Conformance with Checklist Item G
WithersRavenel Project No. 06200820.00
The City of Trinity does not own a wastewater treatment plant (WWTP) and currently sends their
wastewater to the City of Thomasville for treatment. The City has entered into an interlocal agreement
with the City of High Point under which a large percentage of their wastewater will be treated at the City
of High Point's Westside WWTP instead. This will be far more economical than continuing to send flow
to the City of Thomasville and reduce the tax burden on local residents as the City continues to grow.
The proposed pump station upgrades include the installation of new pumps, valves, metering equipment,
SCADA improvements, and an influent grinder at the station, which is located off a private drive at the
end of Tanner Court in Trinity, NC. The upgrades will increase the station's capacity to allow for future
growth and re-routing of existing flow to the station per City of Trinity staff. The proposed force main
includes 30,000 LF of 12" PVC and ductile iron pipe from the Steeplegate pump station to a discharge
manhole in the City of High Point on South Road, just north of its intersection with Lambeth Ave. The
force main will pass through the City of Thomasville and will have sections in Randolph, Davidson, and
Guilford Counties.
The upgrades will add zero flow to the City of Trinity system but will transfer existing flow to the City of
High Point collection system and Westside WWTP. The proposed discharge location in High Point will
allow pumped wastewater to be conveyed directly to the Westside WWTP by gravity sewer via the
existing Ensley Creek outfall line which is 15" diameter at the discharge point and increases to 18"
diameter downstream. The design pumping rate for the station following upgrades will be 1.7 MGD to
ensure that velocity in the force main is higher than 3.0 ft/s for keeping solids suspended. However, the
total allocated flow at the Westside WWTP is 1.0 MGD. The total average daily flow from the pump
station to the WWTP will be tracked using a flow meter and Supervisory Control and Data Acquisition
(SCADA) system at the station.
The proposed project will modify the existing permit (WQ0018816) for the pump station. The existing
permit includes approximately 5,000 linear feet of 8-inch gravity sewer, 4,900 linear feet of 12-inch
gravity sewer, and 165 linear feet of 16-inch gravity sewer; a 139-gallon per minute pump station with
duplex pumps, on -site and audible high water alarms, and automatically -activated stand-by generator; as
well as approximately 4,600 linear feet of 4-inch force main and 3,300 linear feet of 8-inch force main
and 370 linear feet of 12-inch dry force main to serve 60 three -bedroom residences as part of the Phase
I Sewer System Improvements project, and the discharge of 21,600 gallons per day of collected domestic
wastewater into the City of Thomasville's existing sewerage system, pursuant to the application received
April 16, 2001.
The modified permit would include replacing the 139-gallon per minute pump station with a 1,181-
gallon per minute pump station with duplex pumps, on -site audible and visual high water alarms,
telemetry, and a permanent generator with automatic transfer switch; as well as adding approximately
30,000 linear feet of 12-inch of PVC force main to serve 60 three bedroom residences as part of the
City of Trinity Lift Station and Force Main Regionalization Project, and the discharge of 21,600 gallons
per day of collected domestic wastewater into the City of High Point's existing sewerage system,
pursuant to the application received July 8, 2022.
115 MacKenan Drive I Cary, NC 27511
t: 919.469.3340 1 f: 919.467.6008 1 www.withersravenel.com I License No. F-1479
Asheville I Cary I Charlotte I Greensboro I Pittsboro I Raleigh I Southern Pines I Wilmington

-74-202j? State of North Carolina
W �1 Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources ��y �/ FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number:"ON 3p5,3 (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Trinity (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Stevie Cox per 15A NCAC 02T 0106(b)
Title: City Manager
4. Applicant's mailing address: PO Box 50
City: Trinity State: NC Zip: 27370-0050
5. Applicant's contact information:
Phone number: (3� 431-2841 Email Address: citymanager{a trinity-nc.gov
II. PROJECT INFORMATION:
1. Project name: City of Trinity Lift Station & Force Main Regionalization Project
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: WQCS00363 and issued date: Data not available
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is locate Randolph Davidson. and Guilford Counties
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.86006' Longitude:-80.039433`
5. Parcel ID (if applicable): 6796199530 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: J. Clark Maness License Number: 047235
Firm: WithersRavenel, Inc
Mailing address: 115 MacKenan Drive
City: Cary State: NC Zip: 27511-7903
Phone number: [phone] Email Address: cmaness withersravenel com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Westside W WTP Permit Number: NCO024228
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ (Data not available. Easley Creek Sewer Outfall was constructed in 1958/1961)
2. Downstream (Receiving) Sewer Information: 18 inch ® Gravity ❑ Force Main
3. System Wide Collection System Pemrit Number(s) (if applicable): WQCS00010
Owner Name(s): City of High Point
FORM: FTA 06-21 Pagel of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ® N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes [:]No ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
[-]Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater : _% Domestic _% Commercial _% Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ❑ No
➢ If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a,n
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
® Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
® Flow has already been allocated in Permit Number: WOCS00363 Issuance Date: Data not available
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21 Page 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VILL PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Steenlep_ate Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.86006' Longitude:-80.03943'
3. Total number of pumps at the pump station: Two
3. Design flow of the pump station: 1_7 millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): 1 181 gallons per minute (GPM) at 218 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
12
30,000
C900 PVC
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.0IC. Lb. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
® Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B):
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry
Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel tinmeframmmes, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(f) & (2)? ® Yes ❑ No
I SA NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
2Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HOW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T.0305(fl or (g). see Section X.1 of this application
* 15A NCAC 02T.0305(a) contains alternatives where separations in 02T.0305(fl cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/scaled by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: Randleman Lake ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .02009 ® Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications must be being prepared,
have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedimentation control plans, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravitv Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
2. Professional Engineer's Certification:
I, 3. UARI( MANFSS,attest that this application forCiTYOFTR)NIlYUFr STAYIdn/$'GOR(6AAIn/R66navYwns,
(Professional Engineer's name from Application Item 111.1.) (Project Name from Application Item 1.1) PIMIrCr
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
�t 1
2. OFESS/O�• �
a SEAL Syr -
•. G�47235
2 `6/la
P
��i�n•• "Co
I, Stevie L. Cox , attest that this application for City of Trinity Lift Station & Force Main Regionalization Proiect
(Signature Authority Name from Application Item 1.3.) (Project Name from Application Item 11.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-2I5.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: (� e_ (;,, ,
Date: IrAMA— Vg '4
FORM: FTA 06-21 Page 5 of 5

State of North Carolina
Department of Fnvironntental Quality
j ])!vision of Water Resources
Flow Traeldug for Sewer Extension Applications
I)ivii ivn n( VJriicr Itl+sn[n<a v (FTSE 10-18)
Application Number: 2020-179
Entity Requesting Allocation: City ofHigh Point
Project Name for which flow is being requested: Trinity Wastewater Regionalization
Mom their one PTSE maybe i equired for a s11191eIM0*1 trifle orvller of fhe IVIVTP Is nol responsible for all ptrurp
slelloas along the Tonle of the proposed Ipeslespetei- low.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility name: Westside WWTP
b. WWTP Facility Permit II: NC-0024228
A11 floips are In MGD
c. WWTP facility permitted flow: 10.0000
d. Estimated obligated flow not yet tributary to the WWTP: 0.1483
e. WWTP facility's actual average flow: 3.0842
f. 'total flow for this specific request: 1.0000
g. Total actual and obligated flows to the facility: 4.2324 1
If. Percent of permitted flow used: 42.32%
I1. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP.
(A)
(g)
(C)
(D)-(INQ
(g)=(A-D)
Pump
Pump
Firm
Design
Approx.
Obligated,
Total Current
Available
Station
Station
Capacity)
Average
Current
Not Yet
Flow Pius
Capacity s
(Name or
Permit
Daily Flown
Avg Daily
Tributary
Obligated
Number)
Number
(FimJpo,
Flow,
Daily Flow,
Flow
MGD
MOD
MGD
MGD
MGD
MGD
MIA
RWA
RWA
RWA
HNIA
MA
eWA
HWA
HWA
HWA
HWA
RWA
HWA
RWA
AWA
UWA
RWA
HWA
HNIA
AWA
RWA
MIA
RWA
RWA
RWA
UWA IINIA RNIA MA RWA UWA
"The Flrm Capndty (design flaar) of any Pmnp slntim1 is defined ns the nmslnimn pumped flue that
can be achieved with lice largest pump Inkell out of service.
e" Design Avernge Plow is the flrm Cnpncltyof the pump stnllon divided by the peaking fnctos• (po not
less tlinn 2.5, per Section 2.02(A)(4)(c) of the Minhnum Design Criteria.
sAA A Planing Assessment Addendum slmll be attached for ench pump station located between file
project canncellon polnt mid the W WTP avlia•c llic Avnllnble Capncity Is 5 0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
HWA
HWA
RWA
NNIA
HWA
NWA
MA
RWA
Pago 1 of 6 FTSE 10-10

III. Certification Statement
I, Derrick Q. Boone certify to the best of my knowledge that the addition of the volume of
wastewater to be permitted in this project has been evaluated along the route to the receiving wastewater
treatment facility and that the flow from this project is not anticipated to cause any capacity related
sanitary sewer overflows or overburden any downstream pump station en route to the receiving treatment
plant under normal circumstances, given the implementation of the planned improvements identified in the
planning assessment where applicable. This analysis has been performed In accordance with local
established policies and procedures using the best available data. This certification applies to those items
listed above in Sections I and 11 plus all attached planning assessment addendums for which I am the
responsible party. Signature of this form certifies that the receiving collection system or treatment works
has adequate capacity to transport and treat the proposed new wastewater.
Date
ASvj%iA(r PiJi -Ig SGP✓t�i-5 Dil'Ec7at
TYtfe of Signing OJfIciai
9/20/2022
Page 2 of 6 FTSE 1048

1% WitheFSRavenel
July 5, 2022
North Carolina Department of Environmental Quality
Department of Water Resources
Attn: Water Quality Section
Winston Salem Regional Office
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
RE: City of Trinity Lift Station & Force Main Regionalization
Fast Track Application
WithersRavenel Project No. 06200820.00
To whom it may concern
On behalf of the City of Trinity, WithersRavenel is submitting the attached application to your office for
approval of a Fast Track Sewer Permit for the Steeplegate Lift Station and Force Main Wastewater
Regionalization Project.
The City of Trinity (City) does not own a wastewater treatment plant (WWTP) and currently sends their
wastewater to the City of Thomasville for treatment. The City plans to enter into an agreement with the
City of High Point under which a large percentage of their wastewater will be treated at the City of High
Point's Westside WWTP instead. This will be far more economical than continuing to send flow to the
City of Thomasville. The proposed project involves upgrades to the existing Steeplegate pump station to
convey wastewater to the City of High Point's collection system and WWTP.
The City of Trinity and the City of High Point are in the process of adopting an interlocal agreement for
the City of High Point to receive and treat the wastewater that will be conveyed from the Steeplegate
Pump Station. As of the date of this letter, the two cities have not reached a formal agreement, and
therefore the Flow Tracking for Sewer Extension Applications Form (FTSE) has not been executed by the
City of High Point. The FTSE form will be provided once the interlocal agreement between the two cities
is finalized and executed.
The proposed pump station upgrades include the installation of new pumps, valves, metering equipment,
SCADA improvements, and an influent grinder at the station, which is located off a private drive at the
end of Tanner Court in Trinity, NC. The upgrades will increase the station's capacity to allow for future
growth and re-routing of existing flow to the station per City of Trinity staff. The proposed force main
includes 30,000 LF of 12" PVC and ductile iron pipe from the Steeplegate pump station to a discharge
manhole in the City of High Point on South Road, just north of its intersection with Lambeth Ave. The
force main will pass through the City of Thomasville and will have sections in Randolph, Davidson, and
Guilford Counties.
The upgrades will add zero flow to the City of Trinity system but will transfer existing flow to the City of
High Point collection system and Westside WWTP. The proposed discharge location in High Point will
allow pumped wastewater to be conveyed directly to the Westside WWTP by gravity via the existing
Ensley Creek outfall line which is 15" diameter at the discharge point and increases to 18" diameter
downstream. The design pumping rate for the station following upgrades will be 1.7 MGD to ensure that
velocity in the force main is higher than 3.0 ft/s for keeping solids suspended. However, the total allocated
flow at the Westside WWTP is 1.0 MGD. The total average daily flow from the pump station to the WWTP
will be tracked using SCADA and flow meters at the station.
115 MacKenan Drive I Cary, NC 27511
t: 919.469.3340 1 f: 919.467.6008 I www.withersravenel.com I License No. F-1479
Asheville I Cary I Charlotte I Greensboro I Pittsboro I Raleigh I Southern Pines I Wilmington

%0 WithersRavenel
40
The force main route will include encroachment on multiple NCDOT and local road right-of-ways, one
NCRR rail line, one CSX rail line, and two Duke Energy high voltage overhead power line easements.
Applications have been submitted for these encroachments. An erosion control permit application has
also been submitted to the NCDEQ Department of Energy, Mineral, and Land Resources.
The application package includes the following:
• Fast Track Sewer Extension Application Form (FTA 04-16)
• USGS and aerial location maps
• Check for $480.00 application fee
Please do not hesitate to contact me should you have any questions or concerns. We look forward to
working with you on this project.
Sincerely,
WithersRavenel
6t14 r1'GaMwl-
Clark Maness, P.E.
919-535-5213
[e-mail]
CC: Stevie Cox, City Manager for the City of Trinity
115 MacKenan Drive I Cary. NC 27511
t 919.469.3340 1 f: 919.467,6008 I www.withersravenel.com I License No. F-1479
Asheville I Cary I Charlotte I Greensboro I Pittsboro I Raleigh I Southern Pines I Wilmington

NC Department of
Environmental Quality
Received
00 WithersRavenel
NO
JUL 0 8 Y022 Letter of Transmittal
Winston -Sale
115 Macl<enan Drive Regional offic
Cary, NC 27511
t: 919.469.3340 1 f: 919.467.6008
TO: NCDEQ - Winston-Salem Regional Office
450 West Hanes Mill Rd., Suite 300
Winston-Salem, NC 27105
lR,g,.nal,,a
7/6/2022 •: • 06200820.00
Lon SniderTrinity Lift Station and Force Main Wastewater
tion -Fast Track Sewer System Extension Application
WE ARE SENDING YOU © Attached ❑ Under Separate Cover via
THE FOLLOWING ITEMS ❑ Shop Drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of Letter ❑ Change Order ❑ Diskette ❑ Other
COPIESDATE
2
7/5/2022
NO
1
DESCRIPTION
Cover Letter
1
7/5/2022
2
Application Fee
2
7/5/2022
3
Fast Track Application
2
7/5/2022
4
Site Maps
2
7/5/2022
5
Existing Permit
THESE ARE TRANSMITTED as checked below:
❑ For approval ❑ Approved as submitted
❑ For your use ❑ Approved as noted
❑ As requested ❑ Returned for corrections
® For review and comment ❑ Other
❑ FOR BIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS: Please find the attached Fast Track Sewer Extension Application.
Do not hesitate to reach me at 919-535-5213 or at cmanessCawithersravenel.com.
COPY TO: City of Trinity SIGNED: J. Clark Maness, PE
❑ Resubmit
❑ Submit
❑ Return
If enclosures are not as noted, kindly notify us at once
copies for approval
copies for distribution
corrected prints

I
Steeplegate PS
Force Main Map
z
MH:'HP21081
j
HIGH POINT
Proposed Discharge MH
40 WithersRavenel
UO
to tSideWhpoint
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1
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West Side WWTP
West
GUILFORD COUNTY
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t 919 469. 4G
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Thomasville City Limits
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Proposed Discharge MH 1
�0 WithersRavenel to City ofHighpoint
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Engineers I Plannersi Surveyors
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4
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LIFT STATION
11,I1c.10) 1'C
,
!
'ath: W,20'20-0820\200820-Trinity Lift Station Force MainAGeonnaresVGIS\Trinity LS FM_Routing Map 8.5x11 USGS.rRxuhted Date: 5/6/2022